Organization
OCHOCO VISION SOURCE LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALISHIA D HOLLAND (BILLING AGENT)
(541) 416-2020
Entity
Organization
Contact information
Practice address
340 NW BEAVER ST, PRINEVILLE, OR 97754-1836
(541) 416-2020
(541) 447-2608
Mailing address
340 NW BEAVER ST, PRINEVILLE, OR 97754-1836
(541) 416-2020
(541) 447-2608
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
332H00000X
Eyewear Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
276135
—
OR
Enumeration date
05/18/2006
Last updated
07/22/2024
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